Abstract
We describe a case of pancreatic tumor associated with a giant type IV
hiatal hernia that had prolapsed into the posterior mediastinum. We
initially performed hiatal hernia repair, followed by laparoscopic
distal pancreatectomy, because the hernia repair enables performing
pancreatectomy safety and in the normal anatomical position.
Keywords: hiatal hernia, pancreatic tumor, distal
pancreatectomy
Introduction
Acquired hiatal hernia is classified according to the location of the
gastroesophageal junction and the extent of the hernia. In type I or
sliding hernia which are the most common hernias, only the
gastroesophageal junction is herniated into the posterior mediastinum.
In the type II hernias, the gastric fundus is herniated into the
mediastinum adjacent to the esophagus, even though the gastroesophageal
junction is in the correct position. In type III (mixed) hiatal hernia,
more than 30% of the stomach is herniated with the gastroesophageal
junction [1]. In type IV giant hernias (0.3%) and congenital
hernias (0.2%), organs other than the stomach are herniated. The most
frequently herniated organs include the colon, small intestine, omentum
and spleen [2] [3]. Intra-abdominal organs, such as the
transverse colon, can herniate along with the stomach; however,
herniation of the pancreas is very rare.
In simultaneous hiatal hernia repair and distal pancreatectomy,
understanding the anatomical features is difficult because of the
displacement of the pancreas. Moreover, thus far, no studies have
reported cases of neoplastic lesions in a prolapsed pancreas.
We present the case of an elderly patient with a pancreatic tumor
associated with a giant type IV hernia that had prolapsed into the
posterior mediastinum and required resection. We also present a
literature review on surgical treatment of this rare disease.